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SMOKING IS BAD FOR YOU. ^ REALLY. Jennifer A Ericksen September 7, 2007. Outline. Smoking statistics & facts Health consequences Smoking cessation Benefits, stats, & what should be covered? What are plans covering? (ATMC Survey) Your options Questions/comments.

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smoking is bad for you

SMOKING IS BAD FOR YOU

^

REALLY

Jennifer A Ericksen September 7, 2007

outline
Outline
  • Smoking statistics & facts
  • Health consequences
  • Smoking cessation
    • Benefits, stats, & what should be covered?
  • What are plans covering? (ATMC Survey)
  • Your options
  • Questions/comments
despite the warnings
Despite the Warnings…
  • 21% of U.S. adults (45.1 million people) are current cigarette smokers.
  • In the United States, 23% of high school students are current cigarette smokers.
  • Each day, about 1,140 persons younger than 18 years of age become regular smokers
how much are we spending
How Much Are We Spending?
  • U.S. spends > $167 billion per year
    • Lost productivity: $92 billion
    • Health care: $75.5 billion
  • Secondhand smoke costs: ~ $10 b annually
  • 2005: Industry spent ~ $13 b on advertising
  • States spend < 3% of $21.3 billion from excise taxes and legal settlements on preventing and controlling tobacco use
mortality morbidity
Mortality & Morbidity
  • Worldwide: ~ 5 million deaths per year
  • > 10 million deaths annually expected by 2020
  • Leading preventable cause of death in U.S.
  • ~ 1 / 5 deaths annually (~438K deaths/year)
    • ~ 38,000 deaths from secondhand smoke exposure
  • Shortened life span of ~ 13 to 14 years
cardiovascular disease heart circulatory system
Cardiovascular Disease (Heart & Circulatory System)
  • Coronary heart disease: 2 - 4 X  risk
  • Doubles risk for stroke
  • >10 times more likely to develop peripheral vascular disease
    • Narrows blood vessels & reduces circulation
  • Abdominal aortic aneurysm
cancer
Cancer
  • Second leading cause of death
  • 90% of lung cancer deaths in women
    • 13 times higher risk of death vs. never smokers
  • 80% of lung cancer deaths in men
    • >23 times higher risk of death vs. never smokers
  • Bladder, oral cavity, pharynx, larynx, esophagus, cervix, kidney, lung, pancreas, and stomach, and acute myeloid leukemia
  • Rates of cancers generally highest in AA men
respiratory disease etc
Respiratory Disease, Etc.
  • COPD: 10 X increased risk of death
    • 90% deaths attributable to cigarette smoking
  • Reproductive and early childhood effects
    • Increased risk for infertility, preterm delivery, stillbirth, low birth weight, and sudden infant death syndrome (SIDS)
  • Women
    • Lower bone density
    • Increased risk for hip fractures
health benefits of cessation
Health Benefits of Cessation
  • Reduced risk of dying prematurely
  • Lowers risk for lung and other types of cancer
    • Risk declines with number of years since smoking cessation
  • CHD risk substantially reduced within 1 to 2 years
  • Reduces coughing, wheezing, and SOB
    • Slower rate of decline in lung function
  • Reduced risk for adverse reproductive outcomes
they want to quit
They Want To Quit!
  • 70% want to quit completely
    • 2005: ~19.2 million (42.5%) adult smokers had stopped 1 day in last 12 months
  • 2005: ~46.5 million former smokers
  • > 54% of U.S. high school

smokers tried to quit smoking

within the preceding year

areas for improvement
Areas For Improvement
  • National Tobacco Control Program goals:
    • Promote cessation among people of all ages
    • Prevent initiation of tobacco use among adolescents
    • Reduce exposure to secondhand smoke
    • Identify disparities related to tobacco use and its effects among different population groups
slide13
Coverage of tobacco-use cessation treatment increases both use of effective treatment and the number of successful quit attempts.
public health service community preventive services task force
Public Health Service & Community Preventive Services Task Force
  • All health plans should provide:
    • Counseling and medications
    • ≥ 4 counseling sessions of ≥ 30 minutes each
    • Rx and OTC nicotine replacement medication
    • At least two smoking cessation attempts per year
    • Eliminate or minimize co-payments or deductibles
hard to believe
Hard to Believe…

Although 66% of Americans under the age of 65 are insured through an employer, only 24% of their employers offer any coverage for tobacco-use treatment.

how much do cessation benefits cost are they cost effective
How Much Do Cessation Benefits Cost? Are They Cost-Effective?
  • More cost-effective than other interventions
    • HTN & Hyperlipidemia programs
  • Cost/expenditure: Benefits > costs by 5 years
  • 10 to 40 cents PMPM for comprehensive benefit
  • Annual cost of tobacco use: ~ $3,400 per smoker or about $7.18 for each pack of cigarettes sold
  • Neonatal health care costs: $704 for each maternal smoker
    • Program for pregnancy saves ~ $6 for each $1 spent
addressing tobacco in managed care program survey
Addressing Tobacco in Managed Care Program: Survey
  • Program mission: To advance integration of tobacco cessation strategies into routine health care within health plans
  • Survey of tobacco control practices and policies in health insurance plans
    • Surveyed 1997, 2000, 2002, 2003
  • 160/215 plans (74%) completed survey
  • >60 million HMO members represented
what are health plans doing atmc survey results
What Are Health Plans Doing? ATMC Survey Results
  • Written clinical guideline: 67%
  • Identification of at least some members who smoke: 89%
    • Health-risk appraisals & phone surveys**
    • Enrollment data used by 12%
    • 15% in 1997
    • Identification of all smokers: 3%
  • Full coverage for ≥ 1 pharmacotherapy: 88%
    • Bupropion most common: 83%
    • 25% in 1997
atmc survey results
ATMC Survey Results…
  • ≥ 1 behavioral intervention: 72%
    • Self-directed online resources**
    • Individual counseling during pregnancy
    • Telephone counseling
    • Other self-help materials
  • Larger plans**
    • Self help materials & pregnancy
  • Smaller plans**
    • Phone & face-to-face counseling
atmc survey results20
ATMC Survey Results…
  • “Teachable moments”
    • Participation in management program forother diseases: 91%
    • Pregnancy: 69%
    • Treatment for chronic illnesses: 65%
    • Following myocardial infarction: 56%
  • Provider education: 50%
    • Coupled with prompts & reminders: 21%
what stands in the way
What Stands in the Way?
  • Health system barriers
    • Resources:
      • Staff, funding, competing priorities
    • System:
      • Data collection, reporting, records
    • Provider compliance
    • Purchaser demand
    • Delayed economic return on investment
      • ROI analysis tool now available online
it s your turn
It’s Your Turn…
  • Kaiser Cessation Program
    • Get a Rx from your physician
    • Participate in smoking cessation class every 2 weeks for 6 weeks
    • Just pay your normal drug co-pay!
    • Telephone counseling at 1-800-NO-BUTTS
  • Visit kp.org/quitsmoking or contact your local health education center
references
References
  • CDC Website
  • McPhillips, et al. Addressing Tobacco in Managed Care: Results of the 2003 Survey Preventing Chronic Disease, July 2006
  • Kaiser Permanente Website and Health Education Center